New guidance from the Institute for Healthcare Improvement describes safe practices for ensuring effective communication among primary care practitioners, specialists and patients. Breakdowns in the referral process are a significant patient safety issue, as they can lead to delays in diagnosis and treatment. Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era outlines a “closed-loop” referral process, a nine-step workflow in which all relevant patient information is communicated to the correct person through the appropriate channels and in a timely manner. The guidance includes tools and strategies for implementing each step of the process as well as solutions for common pitfalls. Also included are general recommendations for stakeholders including clinicians, practice leaders and electronic health record vendors.